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CCRN Additional Material

Terms in this set (44)

Left Ventricular Assist Device
Booster pump implanted in the abdomen with a tube inserted into the left ventricle. An LVAD is a "bridge to transplant" or destination therapy when heart transplantation is impossible.

NOT pulsatile, just a continuous flow. Will not feel a pulse.
LVAD Anatomy
Inflow cannula - in the LV blood flows into it.

Pump - in the abdomen

Drive line - connected to the pump out to the external battery pack.

Outflow cannula: enters the aorta and brings the blood out to the body
LVAD Complications
-Low Von Willinbrands factor.
-Coagulopathic due to foreign body.
-Infection
LVAD indications
Bridge to transplant
Destination therapy
Reversible condition
LVAD INR goal
2-3
LVAD Medications
Aspirin
Coumadin
Unresponsive LVAD pt
NO CPR!! Could tear the device out of the patient's heart.

Auscultate and listen for a hum. If no hum, need to troubleshoot the VAD.

If there is a hum, they are unresponsive for other reasons.
Intra-aortic balloon pump
Pneumatic pump that provides counter pulsation offloading the LV. Is a retrograde catheter inserted into the descending aorta via the femoral artery.

It inflates in diastole and deflates in systole.

This increases coronary blood flow and DBP during diastole.

It decreases after load and SBP during systole.

Keeps the MAP the same!!
IABP Contraindications
Aortic regurgitation
Atherosclerotic aorta
Aortic dissection
ECMO
Centrifugal pump. Has an inflow catheter to the RA via the FV, and an outflow catheter into the descending aorta via the FA. Full CO support.
VA ECMO
-Supports heart and lungs
-outflow catheter takes blood from patient
-Blood goes through an oxygenator and external VAD
-Inflow catheter takes blood back to patient
-Provides full support: cardiac output and doing the job of the lungs.
-Bypass at the bedside
VV ECMO
-Blood exits the venous side and is oxygenated and then returned to the venous side too.
-Only supports the lungs
-ARDS
Volume control
Sets a tidal volume.

By setting a tidal volume and a respiratory rate, you know the minute ventilation.

Beneficial for achieving a specific PaCO2.

Can result in high peak pressures if compliance decreases. Can also cause dysyncrony.
Pressure Control
Sets a pressure in order to achieve a desired tidal volume.

TV can be unstable with a change in compliance and resistance.
Assist/Control (AC)
A minimum number of preset mandatory breaths are delivered by the ventilator, but the patient can also trigger assisted breaths.

The patient makes an effort to breath and the ventilator assists in delivering the breath.

The breaths are not spontaneous. They are patient triggered, but the breaths are still delivered by the ventilator.

Provides full support. Keeps work of breathing requirement low.

Complication: Hyperventilation resulting in respiratory alkalosis.
Synchronous Intermittent Mandatory Ventilation (SIMV)
The ventilator delivers a preset number of mandatory breaths, but also allows the patient to trigger additional breaths in between mandatory breaths. Can set a controlled pressure or a controlled volume.

Partial ventilatory support. Patient can contribute to some of their minute ventilation. Helps wean off the ventilator. Reduces V/Q mismatching.
Cranial Nerve I
Olfactory
Cranial Nerve II
Optic
Cranial Nerve III
Oculomotor
Cranial Nerve IV
Trochlear
Cranial Nerve V
Trigeminal
Cranial Nerve VI
Abducens
Cranial Nerve VII
Facial
Cranial Nerve VIII
Vestibulocochlear
Cranial Nerve IX
Glossopharyngeal
Cranial Nerve X
Vagus
Cranial Nerve XI
Spinal accessory
Cranial Nerve XII
Hypoglossal
Olfactory
Smell
Optic
Sight
Oculomotor
Movement of eyelids
Adjust pupils and lenses of eyes
Trochlear
Movement of the eyeballs
Trigeminal
Movement of facial muscles
Chewing
Facial expressions
Abducens
Movement of eyeballs
Facial
Produces tears
Taste
Saliva production
Facial expressions
Vesticulocochlear
Auditory
Glossopharyngeal
Swallowing
Saliva production
Taste
Vagus
Peripheral nervous system
Smooth muscle of GI tract
Spinal accessory
Moving head and shoulders
Swallowing
Hypoglossal
Moving tongue
Speech
Swallowing
Cranial Nerve Mnemonic
Oh
Oh
Oh
To
Touch
And
Feel (a)
Virgin
Girl's
Vagina
And
Hymen
Therapeutic Hypothermia
Reduction in body temperature to 32-34C within hours after cardiac arrest to decrease the risk of neurological injury.

Decrease metabolism and demand for oxygen.
Indications for Therapeutic Hypothermia
Not following commands or having purposeful movements after arrects
Contraindications for Therapeutic Hypothermia
Active uncontrolled bleeding
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